Nephrology Book


Type 2 Renal Tubular Acidosis

Aka: Type 2 Renal Tubular Acidosis, Type II Renal Tubular Acidosis, Type II RTA, Proximal RTA, Proximal Renal Tubular Acidosis
  1. Epidemiology
    1. Most commonly affects children
  2. Pathophysiology
    1. Proximal Tubule defect of bicarbonate reabsorption
    2. Results in bicarbonate wasting
      1. Initially distal tubule attempts to reabsorb
      2. Later distal tubule mechanisms overcome
  3. Causes
    1. Medications
      1. Acetazolamide
    2. Fanconi's Syndrome
    3. Medullary cystic disease
    4. Multiple Myeloma
    5. Nephrotic Syndrome
    6. Renal Transplantation
  4. Signs (Presentation)
    1. Failure to Thrive
    2. Growth retardation
    3. Vomiting
    4. Dehydration
    5. Lethargy
  5. Labs
    1. Arterial Blood Gas
      1. Mild to moderate Non-Anion Gap Metabolic Acidosis
    2. Serum bicarbonate decreased
      1. Usually not lower than 15 meq/L
    3. Urine pH
      1. Exceeds 5.5 except in severe Metabolic Acidosis
    4. Fractional Excretion of Bicarbonate
      1. FE-HCO3 exceeds 15% if serum bicarbonate >20 meq/L
      2. FE-HCO3 <5% in Distal RTA
  6. Radiology: XRay
    1. Children: Rickets
    2. Adults: Osteopenia
  7. Management
    1. High dose Bicarbonate Supplementation
      1. Oral Bicarbonate 10-25 meq/kg/day
    2. Observe for Hypokalemia
    3. Treat Osteomalacia in adults
      1. Vitamin D supplementation
      2. Calcium Supplementation
    4. Treat Rickets in children
      1. Vitamin D Supplementation
      2. Sodium Phosphate 1.6 grams per day

You are currently viewing the original '\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree